ABSTRACT

Background

Repair of inguinal hernias in men is a common surgical procedure, but the most effective surgical technique is unknown.

Methods

We randomly assigned men with inguinal hernias at 14 Veterans Affairs (VA) medical centers to either open mesh or laparoscopic mesh repair. The primary outcome was recurrence of hernias at 2 years. Secondary outcomes included complications and patient-centered outcomes.

Results

Of the 2164 patients who were randomly assigned to one of the two procedures, 1983 underwent an operation; 2-year follow-up was completed in 1696 (85.5%). Recurrences were more common in the laparoscopic group (87 of 862 patients [10.1%]) than in the open group (41 of 834 patients [4.9%]; odds ratio, 2.2; 95% confidence interval, 1.5−3.2). The rate of complications was higher in the laparoscopic surgery group than in the open surgery group (39.0% vs. 33.4%; adjusted odds ratio, 1.3; 95% confidence interval, 1.1−1.6). The laparoscopic surgery group had less pain initially than the open surgery group on the day of surgery (difference in mean score on a visual analog scale, 10.2 mm; 95% confidence interval, 4.8−15.6) and at 2 weeks (6.1 mm; 95% confidence interval, 1.7−10.5) and returned to normal activities 1 day earlier (adjusted hazard ratio for a shorter time to return to normal activities, 1.2; 95% confidence interval, 1.1−1.3). In prespecified analyses, there was a significant interaction between the surgical approach (open or laparoscopic) and the 158type of hernia (primary or recurrent) (P = 0.012). Recurrence was significantly more common after laparoscopic repair than after open repair of primary hernias (10.1% vs. 4.0%), but rates of recurrence after repair of recurrent hernias were similar in the two groups (10.0% and 14.1%, respectively).

Conclusions

The open technique is superior to the laparoscopic technique for mesh repair of primary hernias.